Insulin therapy in DM Flashcards
how is endogenous insulin catabolized?
60liver/ 40kidney
how is subQ insulin catabolized?
60kidney/40liver
remember in pts with CKD that what?
kidney bears the weight of catabolizing insulin
-decrease insulin dose b/c it is staying on board longer
when would you use a U500?
in cases of severe insulin resistance
how did they make the insulin fast/slow acting?
changed the amino acid structure to allow to either be more readily or more slowly absorbed
what should you consider when starting to treat DM II pts with insulin?
are you working to augment or replace insulin?
are they coming out post op? hospitalizes? illness? glucose toxicity?
what is the process for glargine (insulin augmentation) in the type II DM?
10units QHS and titrate up in 2 unit increments based on FBS (morning sugars)
what are the steps to calculate multiple daily injections?
Step 1 type 1 0.2-0.6u/kg, type 2 0.4-1.0 u/kg (gives you a TDD)
Step 2 TDD x 0.5 (gives you daily basal dose)
Step 3 TDD x 0.5 (divide this by 3 to get injection amount at each meal)
why do you need to give more insulin to type II DM?
they are resistant to insulin
how do you assign the pre-mix insulin dosing for type II diabetics?
60% of TDD in the am
40% of TDD in the pm
why would you want to adjust basal insulin levels with an insulin pump?
in the morning, the body releases cortisol and GH which causes glucose levels to go up
what are presenting sxs of type 1 DM?
polydipsia/polyuria
SOB
fruity breathe
visual blurring
what are presenting sxs of type 2 DM?
obese polyuria visual blurring acanthosis nigrans yeast/skin infections neuropathy
what causes dehydration of type 1 DM?
osmotic diuresis
